Tips from Other Journals

Routine Replacement of Peripheral IV Catheters

Am Fam Physician. 1998 Jun 1;57(11):2848.

Patients with intravenous catheters may experience phlebitis, catheter-related infections and obstruction of the catheter. In 1981, the Centers for Disease Control and Prevention (CDC) recommended routine replacement of peripheral intravenous catheters every 48 to 72 hours “because of a sharp increase in the rate of infection after this length of time.” Guidelines from the CDC in 1996 continued to recommend rotating catheter sites at 48- to 72-hour intervals. Bregenzer and colleagues evaluated the risks associated with leaving peripheral intravenous catheters in place for as long as they are needed.

A total of 451 patients were enrolled in the study, and 609 catheters that were left in place for one to 28 days were evaluated. The study population included consecutive patients in surgical and medical intensive care units. No disinfection was allowed before removal of the catheter to prevent false-negative results. On removal, the catheter was sent for laboratory analysis.

Clinical complications occurred with 156 catheters (25.6 percent). These complications included phlebitis (19.7 percent), catheter-related infections (6.9 percent) and obstructions (6.0 percent). No significant increase was apparent in the day-specific risk for any of the outcome variables after the second day of catheter placement. The mean duration of catheterization was 3.9 to 4.6 days for catheters with obstruction, phlebitis and positive culture results, which did not differ significantly from those without complications. A total of 223 catheters were left in place for more than three days. No catheter-related bloodstream infections occurred in the study subjects.

The authors conclude that a correlation between phlebitis and catheter infection could not be confirmed. The data suggest that the risk depends on the total number of days that a catheter is in place and not on the duration of use of a single catheter. The additional cost and discomfort for the patient do not support routine replacement.